The Biller/Collector III will efficiently and effectively bill and collect monies relative to physician reimbursements. Works on specific types of accounts (e.g. transplant cases, cardiothoracic surgeries and other advanced type of special accounts, Prop 99, etc.) in a team environment to fulfill the mission and goals of the Department. Works independently requiring little supervision from management to ensure the integrity of the work performed.
Job Duties and Responsibilities:
Coordinate and follow through on the reimbursement activity for specific patient accounts (e.g. Multi-specialty areas including, but not limited to, OB/GYN, Hematology/Oncology, Cardiology, Orthopedic, Urology, Neurology, Transplant cases, etc).
Initiates measures that result in account resolution.
Ensures all conditions for payment receipt have been satisfied.
Responds timely and accurately to all incoming related correspondence and inquires from payers, patients and other authorized parties. Reports any trends in incoming correspondence to managers for appropriate follow-up.
Interacts with co-workers and other representatives to acquire required information on a timely basis.
Initiates contact with patients as needed.
Initiates recommendations and actions for resolving patient accounts. Evaluate accounts to determine any write-offs or corrections required, including duplicate charges.
Submit bills to insurance for secondary insurance.
Ensure that all vital documentation and information is accurate according to departmental policies and procedures. Ensure that all documentation is complete for submission to determine ultimate action on patient account.
Ensure that all applicable monies are transferred from the hospital so that they may be posted accordingly.
Answer telephones, patient inquiries, and respond appropriately to written correspondence relative to a patient's account.
Research and prioritize incoming mail, resubmit denials with accurate documentation.
Verify accurate initial subscriber billing information and update information in the system as required.
Prepare refund request for any or all monies due to patient or insurance company as a result off overpayments or forward requests to appropriate individual in charge of processing refund requests.
Post adjustments to accounts in accordance with departmental policies and procedures.
Respond to all phone calls from other departments or insurance companies in an efficient and courteous manner.
Demonstrate teamwork and provide assistance with special projects when assigned.
Create correspondence and provide documentation for effective reimbursements.
Responsible for updating information within the Epic system (charges, adjustments, write-offs, bad debt, refunds to patients/insurance companies, and professional courtesies). Responsible for processing non-sufficient funds checks and ensure follow-up with those patients in these categories.
Clearly detail within the patient's account, actions taken on the account and any other follow-up that was done, including what the expected outcome should be.
Trains co-workers on sophisticated or specialized client and billing procedures, as needed.
High school diploma or GED required.
Five to seven (5-7) years experience performing medical billing functions. Includes corresponding with patients and insurance companies in resolving patient accounts. Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements.
Experience with online Accounts Receivable billing systems (Epic system experience a plus). Knowledge of PC based software applications (e.g. Outlook, Word, Excel, etc.).
Working Title: Biller/Collector III - Physician Reimbursement Services
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major t...eaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.